As the presidential race has moved beyond the summer's celebratory political conventions and into the hand-to-hand combat that typically marks the final weeks before elections, we can expect to hear a lot more about the rising cost of health care and the dilemma of the uninsured. Everyone is pushing for change, whether it is the Democrats' increased access to government-funded health care or the Republicans' tax incentives and market-based solutions.

But what is really likely to happen when a new President and Congress are sworn in next year? How can you sort out the political hot air and hyped campaign promises from the reality of what may impact your organization and employees--and how should you prepare your company to take advantage of the coming trends?

What to Expect

Those of us who follow the health care industry closely are all too familiar with the political dynamics that will still exist, regardless of who wins in November. Throw out the wishful thinking and we are left with one almost-certain and two probable trends:

1. More of the same. The country's job-based system for health insurance is too entrenched to disappear. The health care industry generates about $2 trillion ­ that's trillion, with a T ­ in economic activity annually, which means they have a strong interest in preserving the status quo. That means employers will be forced to continue down the path of using consumer-directed strategies and cost-sharing plans to escape the expensive, anti-competitive burden that health benefits have become.
2. Change around the edges. Although major reform isn't likely, proposals that have not been successful in the past may become more attractive as politicians look for something they can claim as a health care victory. For example, tax incentives to encourage more families to purchase health insurance have some degree of support across party lines. Another possibility: provisions to allow small businesses and sole proprietorships to band together to access more affordable coverage through purchasing pools.
3. Increasing clarity. Expect continued pressure on health care providers to make their charges more transparent so that consumers can make choices based on real cost comparisons. In addition, Medicare's recent decision to force hospitals to absorb the cost of opportunistic infections ­ caused by pathogens at the hospital that compromise an unhealthy immune system ­ should raise consumer awareness of quality-of-care issues.

How to Prepare

The bottom line is that the one-size-fits-all health care plans are a luxury of the past. Employer-provided health benefits will continue to become more customized as companies struggle to balance the competitive advantage of offering employees good, affordable health care with the increasing drag on their bottom line.

Now, more than ever before, benefits professionals will have to become careful, discriminating shoppers who can sort through sales pitches to identify partners who can deliver value-enhanced offerings. What should you look for? Here are a few ideas:

• Deep discounts don't add up to much if the underlying prices are inflated. Look beyond the promises of large insurers and examine the track record of third party administrators who are eager for your business. Expect ­ in fact, demand ­ a partnership that focuses on synergies that drive down cost while simultaneously improving patient care by reducing the inappropriate and often wasteful use of resources.
• Focus on proactive measures that rein in medical costs, rather than relying solely on controlling premium costs. Eighty percent of the average premium goes toward paying claims, providing a large target for money-saving strategies. Explore behavior management, such as wellness incentives and educating employees about the impact of their choices.
• Demand accountability for claims management. Pharmaceutical and medical billing audits can reveal patterns of mistakes and process flaws that can be addressed to lower costs without affecting the quality of care.

Health care benefits used to be a simple matter of picking plain vanilla or moving up to chocolate, or even an adventuresome strawberry. Today, the choices have multiplied greatly. By finding the right partner, you can stay on top of whatever the future holds and position your company to take advantage of game-changing innovations.

Samuel H. Fleet is President and CEO of AmWINS Group Benefits of Warwick, RI, a leading wholesale broker of comprehensive group insurance programs and administrative services. Sam can be reached at sam.fleet@amwins.com.